| NPI | 1558417162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX R4700) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 04-40421) |
| 208600000X Surgery (Licence: OR MD150687) | |
| 208600000X Surgery (Licence: CO DR-48634) | |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2022-08-22 |